Variation in Health Care Practitioners’ HPV Vaccine Communication

Suellen Hopfer², Margaret Wright⁴, Harry Pellman⁵, Richard Wasserman³, Alexander Fiks¹.

¹Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA; ²Public Health, University of California, Irvine, Irvine, CA; ³Pediatrics, University of Vermont College of Medicine, Burlington, VT; ⁴Research, AAP Pediatric Research in Office Setting, Elk Grove Village, IL; ⁵Pediatrics, UC, Irvine, Irvine, CA.

Presented at the 2017 Pediatric Academic Societies Annual Meeting.

Background: Adolescent HPV vaccination coverage continues to be suboptimal. Modifying health care practitioners' communication practices may offer a unique opportunity to increase vaccination.

Objective: To identify distinct HPV vaccine communication practices that practitioners use with parents of 11-12 year old children.

Methods: A 2016 electronic survey of pediatric health care practitioners from the American Academy of Pediatrics Pediatric Research in Office Settings national practice-based research network. Survey contained five hypothetical case histories, participants responded to questions that captured information about strength of HPV vaccine recommendation, communication style (e.g., uniform vs risk-based), judgment of patient sexual maturity, and perception of what their colleagues do. Latent class analyses (LCA) identified distinct practitioner subgroups based on reported communication practices. Multivariate logistic regression identified predictors of subgroup membership.

Results: 470 practitioners (40% response rate) from 47 states completed the survey. Participants were predominantly female (62%), white (86%), averaged 53 years old, 22 years in practice, and 64% reported at least 25% or more of their patients use Medicaid. Ten percent of practitioners prioritized HPV vaccination over other adolescent vaccines. The three-class model fit the data best: (Class 1) Strongly recommended HPV vaccine using multiple communication strategies and believed their peers did the same (52% of sample); (Class 2) Strongly recommended HPV vaccine and used a normative approach when talking with parents i.e offerred HPV along with other routine adolescent vaccines (20% of sample); (Class 3) Often failed to strongly recommend HPV vaccination, did not believe their peer practitioners strongly recommended, and relied in part on sexual maturity judgment to gauge recommendation strength (28% of sample). Practitioners reporting that >25% of their patients use Medicaid were half as likely to be in Class 3 relative to Class 1 (OR: 0.5, 95%CI: .34, .94). White practitioners were nearly half as likely to be in Class 2 relative to Class 1 (OR: 0.4; 95%CI: .19, .83).

Discussion: Although two-thirds of practitioners strongly recommended HPV vaccination at the recommended age of 11-12, one third (28%) did not. Practitioner-centered interventions are needed to ensure universal adoption of consistent, timely, and urgent messaging to parents.